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Laparoscopic exploration of the common bile duct to relieve choledocholithiasis in children
Seema Menon1, Bhavesh Patel, Eilen Saekang
1Department of Paediatric Surgery, Sydney Childrens' Hospitals Network, Westmead Campus, Sydney, NSW, 2145, Australia. Seemam1@chw.edu.au
Insights
Laparoscopic common bile duct exploration is a safe and effective treatment for pediatric choledocholithiasis. If this fails, endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy is an option.
Area of Science:
- Pediatric surgery
- Gastroenterology
- Hepatobiliary surgery
Background:
- Management of pediatric choledocholithiasis remains controversial.
- Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are effective in adults, but long-term pediatric outcomes are unknown.
Purpose of the Study:
- To report experience with laparoscopic common bile duct (CBD) exploration for choledocholithiasis in children.
- To propose a management algorithm for pediatric choledocholithiasis.
Main Methods:
- Retrospective chart review of 124 children undergoing cholecystectomy over 5 years.
- Data included age, symptom duration, length of stay, choledocholithiasis management, and outcomes.
- Laparoscopic common bile duct (CBD) exploration was performed in 8 patients with identified stones.
Main Results:
- Mean age of patients with choledocholithiasis was 12.5 years.
- Laparoscopic CBD exploration using saline flushes or Dormia basket was successful in 6 out of 8 patients.
- Two patients required postoperative ERCP and sphincterotomy for stone extraction.
- All children were symptom-free at follow-up with no reported complications.
Conclusions:
- Laparoscopic CBD exploration with Dormia basket or saline flushes is a safe and effective alternative for pediatric choledocholithiasis.
- ERCP and sphincterotomy are viable options when laparoscopic exploration is unsuccessful in centers with expertise.
Purpose:
The optimal method of managing paediatric choledocholithiasis is controversial. Endoscopic retrograde cholangiopancreatography (ERCP) and sphincterotomy are effective in adults; however, the long-term outcome in the paediatric population is unknown. We report our experience with laparoscopic common bile duct (CBD) exploration to relieve choledocholithiasis in children and propose a management algorithm.
Methods:
A retrospective chart review of 124 children, who underwent cholecystectomy over 5 years was conducted. Data collected included age at onset, duration of symptoms, length of stay, method of relieving choledocholithiasis and postoperative outcome.
Results:
Mean age was 12.5 years (range 10-14 years). 102 cholecystectomies were performed laparoscopically. Following intraoperative cholangiogram (IOC), choledocholithiasis was identified in eight patients. In three cases, the CBD was flushed with normal saline via a 5F ureteral catheter successfully relieving the obstruction. In three cases, a Dormia basket was used to break down the stone. Two cases required postoperative ERCP and sphincterotomy to successfully extract the stones. All children were symptom-free at follow-up with no complications reported to date.
Conclusion:
Laparoscopic CBD exploration with Dormia basket or saline flushes to relieve choledocholithiasis is a safe and effective alternative in children. If unsuccessful, ERCP and sphincterotomy can be performed in centres with adequate resources and expertise.
